Top Takeaways

• Strokes can cause weakness or paralysis on one side of the body
• It’s common for Stroke survivors to experience physical, cognitive, and sensory effects from a stroke, which can be treated through physical, occupational, and/or speech therapies
• Be aware of the common medical complications that stroke survivors may face, including bedsores, seizures, aspirations, blood clots,  and headaches 
• It’s common for stroke survivors to begin stroke rehab after discharge from the hospital 
• Once a stroke survivor comes home, there are important modifications to make that will make their environment safer    

 

Acute (Abrupt) Emergency Signs of a Stroke 

Many strokes cause strength or movement impairments that affect one side of the body (including arms and legs). This is referred to as Hemiparesis or Hemiplegia. 

 

• Hemiparesis means weakness on one side of the body
• Hemiplegia means paralysis on one side of the body 

 

Weakness or paralysis can also occur in the head or neck areas. Examples include weakness or paralysis of eye, face, or tongue movement, or difficulty swallowing.

 

Other Signs and Symptoms include fairly sudden or unexpected onset of: 

• Nausea and vomiting, particularly when associated with dizziness or vertigo (the sensation that everything is spinning). Sudden dizziness or vertigo has many causes, but only a doctor can determine whether it’s due to a stroke or something else.
• Difficulty chewing or swallowing
• Drooling
• Difficulty speaking (slurred, garbled, or nonsensical speech)

 

If you notice any of these signs or symptoms, IMMEDIATELY seek emergency care. Strokes are medical emergencies, and time is of the essence. Even one hour can mean the difference between successful and unsuccessful treatment. Some medical care is only effective if performed within hours of the time that symptoms started.

Top 10 Chronic Physical Effects of Stroke

 

Common physical deficits after stroke include the following:

 

1. Hemipareis and Hemiplegia

 

2. Spasticity: Spasticity refers to when muscles become stiff and tight. This can affect range of motion and ability to perform many tasks such as walking or activities of daily living.  

 

• • Treatment typically involves PT and OT to rewire the brain, re-establish proper nerve communication, and stretch/loosen the muscles.

 

3. Contractures: Contractures refer to extreme stiffness and bending in the arms or legs that occurs when spasticity is left unmanaged. Contractures are caused by the shortening of muscles or connective tissue that spans one or more joints

 

• • Treatment can involve splints or casts, and movement and stretching exercises often initiated by PT and OT. In advanced cases where contractures cannot be treated with these methods, surgery may be required. This surgery can involve cutting, loosening, or moving certain joints or tendons to free up the arm or leg movement.  

 

4. Post-Stroke Fatigue: Fatigue is common following strokes. As the brain tries to heal itself, this can be a drain on your loved one’s energy. This means: 

• • Everyday tasks may take more energy
  • Your loved one may experience fatigue during the day 
  • Additional sleeping and resting may occur 

 

If excessive sleeping continues later in recovery, speak to your loved one’s doctor. Persistence of increased sleeping and fatigue may indicate another medical condition.

 

5. Balance Issues: If your loved one’s motor abilities were affected by a stroke, they may have poor balance and be at an increased risk of falling. Therefore, it’s essential to be even more vigilant about preventing falls. 

• • Treatment involves PT, and an assistive device, such as a cane or walker. Home modifications may be necessary.

 

6. Dysphagia (Difficulty swallowing): Your loved one’s brain might need to be retrained to control the swallowing muscles.

 

• • Treatment involves ST. In severe cases where ST cannot adequately treat the condition, artificial nutrition may be needed to avoid the swallowing problems. This can include the following tubes to deliver food without the need for swallowing:
    • Nasogastric feeding tube – a tube runs from the nose to the stomach. This type of tube is usually easy to put into place.
    • Gastric feeding tube – a gastroenterologist or radiologist will place this tube into the stomach through a small incision they make on the outside of the abdominal wall. This is a relatively simple procedure.
    • Parenteral nutrition – this nutrition is given through an intravenous line. This is usually reserved for situations where other types of feeding tubes can’t be used due to safety or other medical issues.

 

7. Shoulder complications: Your loved one may experience shoulder pain on the affected side when shoulder muscles are affected by the stroke. Pain or motion difficulty with the shoulder can extend into the arm or hand.

 

• • Treatment can include: 
    • Range of motion exercises 
    • Electrical nerve therapy 
    • Taping
    • Medication 
    • Botox injections 
    • Surgery - If the surgery is minor and will not require major anesthesia, it may be performed if other treatments fail. 

 

8. Foot Drop: Your loved one may have difficulty lifting their foot on the affected side. 

 

• • Treatment can include:  
    • A brace to prop up the foot
    • PT and associated rehabilitative exercises
    • Assistive devices, including canes or walkers

 

9. Curled Toes: Your loved one may curl their toes as a result of spasticity in the feet. 

 

• • Treatment can include:
    • A brace 
    • PT and rehabilitative exercises
    • Botox injections
    • Care by an orthopedist or podiatrist (foot doctor). This care can include special shoe inserts or surgery. If the surgery is minor and will not require major anesthesia, it may be performed if other treatment methods fail.

 

10. Learned Nonuse: If your loved one fails to move their muscles, they may develop nonuse, which causes the brain to have increased difficulty paying attention to the affected muscles. 

• • For this reason, it is crucial to engage in PT and OT as recommended by your senior’s care team. 
  • Any home activities and exercises recommended after formal PT and OT treatments end should be continued as prescribed, or strength and function may be lost.   

 

Many long-lasting physical and other impairments can result from a stroke; these are called “residuals.” Residuals usually require treatment by physical, occupational, and/or speech therapy (PT, OT, ST). 

• • Physical Therapy includes treatment to improve strength and movement, such as walking. 
  • Occupational Therapy  includes treatments to improve function and coordination, such as properly using the hands and fingers. 
  • Speech Therapy includes treatments to improve speech, eating/chewing, and swallowing. 

Chronic Cognitive Effects of Stroke

1. Aphasia: Aphasia refers to difficulty with language, and is common after certain types of stroke.

 

The two main types of aphasia that may occur are:

1. Expressive aphasia – the person can understand what is said to them and what they hear. They know what they want to say to respond. However, when they try to speak, the speech comes out garbled or nonsensical.

2. Receptive aphasia – the person can hear what is said but they cannot make sense of it.

 

Either or both types of aphasia can occur from a stroke. Aphasia can also apply to reading and writing. You can help your loved one by: 

1. Getting Speech Therapy 

2. Developing alternate forms of communication 

 

2. Impaired Memory and Attention: A stroke can affect your loved one’s ability to think clearly, reason, focus, remember, and execute everyday cognitive functions. To help, your loved one can be prescribed cognitive training. Different types of healthcare professionals can render cognitive training or therapy. 

 

3. Behavior Changes:  Your loved one may express angry or aggressive behaviors after suffering from a stroke. Check with your health care provider if this occurs.

 

4. Depression and Anxiety: This is one of the most common complications after a stroke, and can be best treated by a neurologist, primary care provider, or mental health professional.  

 

Sensory Effects

When sensory functions sustain damage following a stroke, it can cause sensory issues such as numbness, pain, or visual disturbances. 

 

As a result, your loved one may need:  

• Sensory reeducation programs 
• Vision restoration therapy 
• Specialized glasses
• Discuss possible additional sensory therapies with your healthcare team

Medical Complications to be aware of in stroke patients

1. Bedsores: Your loved one can develop bedsores if they are laying or sitting for long periods. Help prevent bedsores by repositioning the body every couple of hours. You will need training on how to do this properly and effectively. You may need to hire a trained professional to provide this care; always double-check your insurance coverage before hiring someone. If your loved one is in a facility (e.g., skilled nursing facility), this care will be provided by the facility. 

 

2. Seizures: Some stroke survivors experience seizures. If this happens to your loved one, they may be prescribed an anticonvulsant medication. In severe cases where drugs are ineffective, the doctor may recommend a nerve stimulator.

 

3. Aspiration: There are two types:

 

1. Acute (sudden) -  when stroke survivors with impaired swallowing accidentally inhale food or saliva into the lungs. Aspiration can lead to pneumonia or other serious lung problems. Contact medical professionals immediately if you suspect an unplanned aspiration has occurred.

2. Chronic - some stroke patients frequently aspirate, regardless of medical attempts to prevent this. These patients are managed differently than those with acute aspiration, and throat surgery may be suggested.

 

4.  Deep Vein Thrombosis (Blood clot in a vein): Your loved one has an increased risk of developing a blood clot if:

• • They are relatively immobile after a stroke. 
  • Their stroke was caused by a pre-existing blood clot that formed in or traveled to the brain from somewhere else. 

In either situation, your loved one’s doctor will likely prescribe blood-thinning medication. 

 

5. Post-Stroke Headaches: Chronic headaches may develop after the acute phase of a stroke. Many things can cause these headaches. After evaluation by a doctor, follow the prescribed treatment(s). 

For unexpected new-onset  headaches (those that the doctor is not already well aware of):

• • Seek medical attention immediately if they are:
    1. Moderate or severe
    2. Associated with:
       • Seizure
       • New paralysis or weakness
       • Change in thinking 
       • Change in alertness
       • Fever
       • Nausea or vomiting
       • Any other unexplained sign or symptom

These symptoms could signal critical bleeding in the brain or another life-threatening medical situation. 

 

For new-onset mild headaches without any other signs or symptoms, notify a healthcare provider if simple treatment (e.g., Tylenol™) doesn’t promptly resolve the situation. Never take it upon yourself to treat recurring or ongoing mild headaches without the care of a medical professional. If in doubt, always contact a professional promptly.

Stroke Rehabilitation (“Rehab”) 

Rehab often begins during acute hospitalization for a stroke. After discharge from the hospital, stroke patients are frequently discharged to skilled nursing (or similar) facilities to continue their PT, OT, ST and/or cognitive therapy.

 

The duration of rehab will vary widely depending on the individual’s particular situation.

 

NOTE: At some point, stroke survivors will experience a plateau in the rate at which improvements occur with ongoing therapy. This is due to neurological changes stabilizing. At a certain point, further gains may be limited or not possible with continued treatment.

Make House modifications 

After a stroke, patients may have conditions that make them more likely to fall such as:

• Hemiparesis or hemiplegia
• Persistent dizziness or vertigo
• Other neurologic conditions

 

Home modifications to reduce risk of injury or other dangers may be needed such as: 

• Grab bars
• Non-slip mats or carpets
• Decreasing ground clutter
• Others recommend by PT or OT

 

NOTE: Your loved one’s PT and/or OT program should be consulted for recommendations specific hoe modifications that are tailored to your loved one’s specific situation. 

Manage Stroke Risks

• Properly manage:
• Blood pressure
• Cholesterol
• Stress levels
• Treatments prescribed for transient ischemic attacks (“mini-strokes”)
• Diabetes
• Heart disease
• Smoking

 

• Include: 
• Healthy diets
• Appropriate exercise and activities
• Taking prescribed medication
• Regular healthcare provider visits